Change Request Browser

Change Requests for ASC X12 Work Products

254

Real Time Adjudication

Submitted: 10/1/2010

Business Reason

The eligibility transaction can support an online real-time request/response for various treatment options and the patients out of pocket costs for these treatment options. Consider adding a statement that the eligibility transaction shall support real-time adjudication.

Description

The healthcare arena is quickly moving towards real-time adjudication (RTA). The recent introduction of consumer directed health plans (CDHP) with high deductibles is meant to allow greater patient and provider discussions as to the costs and effectiveness of various treatments. Providers and patients need a mechanism to ascertain exact financial responsibilities for various treatment options before treatment begins.